Life After Cancer

I got this from the "Life After Cancer Discussion Group"  WENDY SCHLESSEL HARPHAM is a cancer survivor -- so far. In the four years since she learned that she had a form of non-Hodgkin's lymphoma, a cancer of the lymph nodes, she has experienced repeated remissions and recurrences and, in the process, learned a great deal about how to live with and after cancer.As a doctor, she had read widely about people who had to deal with chronic and life-threatening illnesses. But she said it was not until she became a cancer patient that she realized that "I wasn't even close to understanding what it was like and I was blind-sided by how difficult it was to feel normal again."Dr. Harpham was a 36-year-old internist in private practice in Dallas, the wife of a professor and the mother of three small children, nearly 2, 4 and 6, when her cancer was found. She was the kind of caring doctor patients flocked to, and she loved every moment of her long days. But her cancer eventually forced her to give up her practice, her dream since the age of 13, and that loss hit her even harder than her hellish rounds of treatment.To take her mind off her misery in her first round of treatment -- seven months of highly toxic chemotherapy -- she started a pamphlet on what to do when cancer is diagnosed, expecting to use it for her patients. The pamphlet became a book, "Diagnosis: Cancer" (W. W. Nortonpaperback, $9.95), and put her on a new career path.Two months into her first remission, she began a second book, to help cancer patients and those who care for and about them understand the long-lasting effects of cancer and its treatment and to move beyond them to forge a new "normal" life."After Cancer: A Guide to Your New Life," just published by W. W. Norton ($23), recognizes that, as she put it in an interview last week: "Most cancer survivors cannot go back to their old normal. They can, however, achieve a new normal by incorporating the physical, emotional and spiritual changes resulting from their cancer experience." For her, and for many other, she said, this new normal is a better one.Although she is far from happy about having cancer, she says that her life has been greatly enhanced by the discoveries and opportunities for growth and enrichment her experience brought her. Cancer has taught her to live in the present, to savor every moment. It has given her more time with her children and husband and an opportunity to get her message out to far more people, professionals and patients, than she could have reached in her practice. Aftermath of CancerToo many patients, Dr. Harpham has discovered, are needlessly crippled emotionally and socially by cancer and its treatment. They have suffered physical and emotional losses that they have failed to mourn, and the unresolved grief blocks them from moving forward. Well-meaning people dismiss their grief with statements like "Don't worry about your missing breast; at least you're alive."Many cancer patients allow themselves to be consumed by fear about a possible recurrence, the Sword of Damocles that destroys the quality of their lives even as things are going well. "It's perfectly normal when you survive a life-threatening disease to feel vulnerable," she said. "Fear of recurrence is much greater than the fear of getting cancer in the first place. It is normal to be anxious before an after-cancer checkup." But, she says, they should focus on making their present life as rich and meaningful as possible.Even in remission, many patients suffer extraordinary fatigue. With their treatment complete, they may expect to perform with their former vigor. But they often cannot, and their failure to meet their own and others' expectations further undermines their self-confidence. The fatigue can also make them irritable and unduly distressed by minor mishaps. Anger can also be a stumbling block. Losses related to cancer or its treatment, like being bypassed for a job, losing a lover or friend or having insurance canceled, can provoke justifiable but life-damaging anger. But perhaps most devastating is a feeling that the person has lost control over his or her life. As Dr. Harpham puts it, "Normal, everyday events that represent lack of control -- car breakdowns, leaky faucets, missed appointments, delayed flights or sprained ankles -- can be blown up out of proportion because of an underlying sensitivity to things you cannot control." What You Can Do"Just as there are normal physiological responses to chemotherapy, there are predictable psychological consequences of cancer, and if you recognize them and prepare for them, you can minimize their effects," Dr. Harpham said. For example, she plans something nice for herself on checkup days. When she finds herself dwelling on negative thoughts, she forces herself to play a more cheerful mental tape.She urges cancer patients to grieve their losses actively, so they can move on. "Find a safe place to cry and cry until you have no more tears," she suggests. Those who feel lonely and misunderstood should take time to explain thoughts and feelings to friends and family, keeping in mind that cancer is new territory for them, too. Support groups of patients and survivors can be extremely helpful. She spurns what she calls "the Rambo approach" to cancer, saying, "Human beings need support and do much better with it.""Instead of worrying about bad things that could happen or things you cannot control, focus on realistic ways to strengthen your physical, emotional and spiritual health," she says. She, for example, is rigorous about exercise and has found great strength from rediscovering her Jewish faith."Recognize your limits and handicaps so that you can work on overcoming the ones that can be overcome and accepting the ones that are unalterable," she wrote. "Complete control is an illusion. Your cancer did not create a loss of control; it revealed the lack of control. If anything, the tools and strengths that you can gain through your cancer experience will allow you to exercise more control over your life after cancer."After two recurrences and experimental treatment, Dr. Harpham is now in remission and about to complete another book, this one for children whose parents have cancer and are expected to survive."Will this remission last?" she asks herself. "We'll find out as I, not 'wait and see' but 'live and see.' " For Dr. Harpham, living means working out on her Stairmaster four times week, writing and lecturing, raising three children and enjoying activities and conversations with her husband. "Do I feel normal?" she asked. "No, but I feel good enough. Life is much easier and more joyful if you see the glass as half full."